System for neuronavigation registration and robotic trajectory guidance, and related methods and devices

ABSTRACT

A position is determined for each fiducial marker of a plurality of fiducial markers in an image volume. Based on the determined positions, a position and orientation of the registration fixture with respect to the anatomical feature is determined. A position is determined for each tracked marker of a first plurality of tracked markers on the registration fixture and a second plurality of tracked markers on the robot arm in a tracking data frame. Based on the determined positions of tracked markers, a position and orientation of the registration fixture and the robot arm of a surgical robot with respect to the tracking space are determined.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation-in-part of U.S. patentapplication Ser. No. 16/361,863 filed on Mar. 22, 2019, which isincorporated in its entirety herein.

FIELD

The present disclosure relates to medical devices and systems, and moreparticularly, systems for neuronavigation registration and robotictrajectory guidance, and related methods and devices.

BACKGROUND

Position recognition systems for robot assisted surgeries are used todetermine the position of and track a particular object in 3-dimensions(3D). In robot assisted surgeries, for example, certain objects, such assurgical instruments, need to be tracked with a high degree of precisionas the instrument is being positioned and moved by a robot or by aphysician, for example.

Position recognition systems may use passive and/or active sensors ormarkers for registering and tracking the positions of the objects. Usingthese sensors, the system may geometrically resolve the 3-dimensionalposition of the sensors based on information from or with respect to oneor more cameras, signals, or sensors, etc. These surgical systems cantherefore utilize position feedback to precisely guide movement ofrobotic arms and tools relative to a patients' surgical site. Thus,there is a need for a system that efficiently and accurately provideneuronavigation registration and robotic trajectory guidance in asurgical environment.

SUMMARY

According to some embodiments of inventive concepts, a system includes aprocessor circuit and a memory coupled to the processor circuit. Thememory includes machine-readable instructions configured to cause theprocessor circuit to determine, based on a first image volume comprisingan anatomical feature of a patient, a registration fixture that is fixedwith respect to the anatomical feature of the patient, and a firstplurality of fiducial markers that are fixed with respect to theregistration fixture, determine, for each fiducial marker of the firstplurality of fiducial markers, a position of the fiducial markerrelative to the image volume. The machine-readable instructions arefurther configured to cause the processor circuit to determine, based onthe determined positions of the first plurality of fiducial markers, aposition and orientation of the registration fixture with respect to theanatomical feature. The machine-readable instructions are furtherconfigured to cause the processor circuit to, based on a data frame froma tracking system comprising a second plurality of tracking markers thatare fixed with respect to the registration fixture, determine, for eachtracking marker of the second plurality of tracking markers, a positionof the tracking marker. The machine-readable instructions are furtherconfigured to cause the processor circuit to determine, based on thedetermined positions of the second plurality of tracking markers, aposition and orientation of the registration fixture with respect to arobot arm of a surgical robot. The machine-readable instructions arefurther configured to cause the processor circuit to determine, based onthe determined position and orientation of the registration fixture withrespect to the anatomical feature and the determined position andorientation of the registration fixture with respect to the robot arm, aposition and orientation of the anatomical feature with respect to therobot arm. The machine-readable instructions are further configured tocause the processor circuit to control the robot arm based on thedetermined position and orientation of the anatomical feature withrespect to the robot arm.

According to some other embodiments of inventive concepts, acomputer-implemented method is disclosed. The computer-implementedmethod includes, based on a first image volume comprising an anatomicalfeature of a patient, a registration fixture that is fixed with respectto the anatomical feature of the patient, and a first plurality offiducial markers that are fixed with respect to the registrationfixture, determining, for each fiducial marker of the first plurality offiducial markers, a position of the fiducial marker. Thecomputer-implemented method further includes determining, based on thedetermined positions of the first plurality of fiducial markers, aposition and orientation of the registration fixture with respect to theanatomical feature. The computer-implemented method further includes,based on a tracking data frame comprising a second plurality of trackingmarkers that are fixed with respect to the registration fixture,determining, for each tracking marker of the second plurality oftracking markers, a position of the tracking marker. Thecomputer-implemented method further includes determining, based on thedetermined positions of the second plurality of tracking markers, aposition and orientation of the registration fixture with respect to arobot arm of a surgical robot. The computer-implemented method furtherincludes determining, based on the determined position and orientationof the registration fixture with respect to the anatomical feature andthe determined position and orientation of the registration fixture withrespect to the robot arm, a position and orientation of the anatomicalfeature with respect to the robot arm. The computer-implemented methodfurther includes controlling the robot arm based on the determinedposition and orientation of the anatomical feature with respect to therobot arm.

According to some other embodiments of inventive concepts, a surgicalsystem is disclosed. The surgical system includes an intraoperativesurgical tracking computer having a processor circuit and a memory. Thememory includes machine-readable instructions configured to cause theprocessor circuit to provide a medical image volume defining an imagespace. The medical image volume includes an anatomical feature of apatient, a registration fixture that is fixed with respect to theanatomical feature of the patient, and a plurality of fiducial markersthat are fixed with respect to the registration fixture. Themachine-readable instructions are further configured to cause theprocessor circuit to, based on the medical image volume, determine, foreach fiducial marker of the plurality of fiducial markers, a position ofthe fiducial marker with respect to the image space. Themachine-readable instructions are further configured to cause theprocessor circuit to determine, based on the determined positions of theplurality of fiducial markers, a position and orientation of theregistration fixture with respect to the anatomical feature. Themachine-readable instructions are further configured to cause theprocessor circuit to provide a tracking data frame defining a trackingspace, the tracking data frame comprising positions of a first pluralityof tracked markers that are fixed with respect to the registrationfixture. The machine-readable instructions are further configured tocause the processor circuit to, based on the tracking data frame,determine a position of the anatomical feature with respect to the firstplurality of tracked markers in the tracking space. The surgical systemfurther includes a surgical robot having a robot arm configured toposition a surgical end-effector. The surgical robot further includes acontroller connected to the robot arm. The controller is configured toperform operations including, based on the tracking data frame,determining a position of the robot arm with respect to the trackingspace. The controller is configured to perform operations includingdetermining, based on the determined position and orientation of theanatomical feature with respect to the tracking space and the determinedposition and orientation of the robot arm with respect to the trackingspace, a position and orientation of the anatomical feature with respectto the robot arm. The controller is configured to perform operationsincluding controlling movement of the robot arm based on the determinedposition and orientation of the anatomical feature with respect to therobot arm to position the surgical end-effector relative to a locationon the patient to facilitate surgery on the patient.

Other methods and related devices and systems, and corresponding methodsand computer program products according to embodiments will be or becomeapparent to one with skill in the art upon review of the followingdrawings and detailed description. It is intended that all such devicesand systems, and corresponding methods and computer program products beincluded within this description, be within the scope of the presentdisclosure, and be protected by the accompanying claims. Moreover, it isintended that all embodiments disclosed herein can be implementedseparately or combined in any way and/or combination.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide a furtherunderstanding of the disclosure and are incorporated in a constitute apart of this application, illustrate certain non-limiting embodiments ofinventive concepts. In the drawings:

FIG. 1A is an overhead view of an arrangement for locations of a roboticsystem, patient, surgeon, and other medical personnel during a surgicalprocedure, according to some embodiments;

FIG. 1B is an overhead view of an alternate arrangement for locations ofa robotic system, patient, surgeon, and other medical personnel during acranial surgical procedure, according to some embodiments;

FIG. 2 illustrates a robotic system including positioning of thesurgical robot and a camera relative to the patient according to someembodiments;

FIG. 3 is a flowchart diagram illustrating computer-implementedoperations for determining a position and orientation of an anatomicalfeature of a patient with respect to a robot arm of a surgical robot,according to some embodiments;

FIG. 4 is a diagram illustrating processing of data for determining aposition and orientation of an anatomical feature of a patient withrespect to a robot arm of a surgical robot, according to someembodiments;

FIGS. 5A-5C illustrate a system for registering an anatomical feature ofa patient using a computerized tomography (CT) localizer, a framereference array (FRA), and a dynamic reference base (DRB), according tosome embodiments;

FIGS. 6A and 6B illustrate a system for registering an anatomicalfeature of a patient using fluoroscopy (fluoro) imaging, according tosome embodiments;

FIG. 7 illustrates a system for registering an anatomical feature of apatient using an intraoperative CT fixture (ICT) and a DRB, according tosome embodiments;

FIGS. 8A and 8B illustrate systems for registering an anatomical featureof a patient using a DRB and an X-ray cone beam imaging device,according to some embodiments;

FIG. 9 illustrates a system for registering an anatomical feature of apatient using a navigated probe and fiducials for point-to-point mappingof the anatomical feature, according to some embodiments;

FIG. 10 illustrates a two-dimensional visualization of an adjustmentrange for a centerpoint-arc mechanism, according to some embodiments;

FIG. 11 illustrates a two-dimensional visualization of virtual pointrotation mechanism, according to some embodiments;

FIG. 12 illustrates a detailed view of the cerebral cortex; and

FIGS. 13A and 13B illustrate the planning of a trajectory forpositioning an electrode deep within the brain.

DETAILED DESCRIPTION

It is to be understood that the present disclosure is not limited in itsapplication to the details of construction and the arrangement ofcomponents set forth in the description herein or illustrated in thedrawings. The teachings of the present disclosure may be used andpracticed in other embodiments and practiced or carried out in variousways. Also, it is to be understood that the phraseology and terminologyused herein is for the purpose of description and should not be regardedas limiting. The use of “including,” “comprising,” or “having” andvariations thereof herein is meant to encompass the items listedthereafter and equivalents thereof as well as additional items. Unlessspecified or limited otherwise, the terms “mounted,” “connected,”“supported,” and “coupled” and variations thereof are used broadly andencompass both direct and indirect mountings, connections, supports, andcouplings. Further, “connected” and “coupled” are not restricted tophysical or mechanical connections or couplings.

The following discussion is presented to enable a person skilled in theart to make and use embodiments of the present disclosure. Variousmodifications to the illustrated embodiments will be readily apparent tothose skilled in the art, and the principles herein can be applied toother embodiments and applications without departing from embodiments ofthe present disclosure. Thus, the embodiments are not intended to belimited to embodiments shown, but are to be accorded the widest scopeconsistent with the principles and features disclosed herein. Thefollowing detailed description is to be read with reference to thefigures, in which like elements in different figures have like referencenumerals. The figures, which are not necessarily to scale, depictselected embodiments and are not intended to limit the scope of theembodiments. Skilled artisans will recognize the examples providedherein have many useful alternatives and fall within the scope of theembodiments.

According to some other embodiments, systems for neuronavigationregistration and robotic trajectory guidance, and related methods anddevices are disclosed. In some embodiments, a first image having ananatomical feature of a patient, a registration fixture that is fixedwith respect to the anatomical feature of the patient, and a firstplurality of fiducial markers that are fixed with respect to theregistration fixture is analyzed, and a position is determined for eachfiducial marker of the first plurality of fiducial markers. Next, basedon the determined positions of the first plurality of fiducial markers,a position and orientation of the registration fixture with respect tothe anatomical feature is determined. A data frame comprising a secondplurality of tracking markers that are fixed with respect to theregistration fixture is also analyzed, and a position is determined foreach tracking marker of the second plurality of tracking markers. Basedon the determined positions of the second plurality of tracking markers,a position and orientation of the registration fixture with respect to arobot arm of a surgical robot is determined. Based on the determinedposition and orientation of the registration fixture with respect to theanatomical feature and the determined position and orientation of theregistration fixture with respect to the robot arm, a position andorientation of the anatomical feature with respect to the robot arm isdetermined, which allows the robot arm to be controlled based on thedetermined position and orientation of the anatomical feature withrespect to the robot arm.

Advantages of this and other embodiments include the ability to combineneuronavigation and robotic trajectory alignment into one system, withsupport for a wide variety of different registration hardware andmethods. For example, as will be described in detail below, embodimentsmay support both computerized tomography (CT) and fluoroscopy (fluoro)registration techniques, and may utilize frame-based and/or framelesssurgical arrangements. Moreover, in many embodiments, if an initial(e.g. preoperative) registration is compromised due to movement of aregistration fixture, registration of the registration fixture (and ofthe anatomical feature by extension) can be re-establishedintraoperatively without suspending surgery and re-capturingpreoperative images.

Referring now to the drawings, FIG. 1A illustrates a surgical robotsystem 100 in accordance with an embodiment. Surgical robot system 100may include, for example, a surgical robot 102, one or more robot arms104, a base 106, a display 110, an end-effector 112, for example,including a guide tube 114, and one or more tracking markers 118. Therobot arm 104 may be movable along and/or about an axis relative to thebase 106, responsive to input from a user, commands received from aprocessing device, or other methods. The surgical robot system 100 mayinclude a patient tracking device 116 also including one or moretracking markers 118, which is adapted to be secured directly to thepatient 210 (e.g., to a bone of the patient 210). As will be discussedin greater detail below, the tracking markers 118 may be secured to ormay be part of a stereotactic frame that is fixed with respect to ananatomical feature of the patient 210. The stereotactic frame may alsobe secured to a fixture to prevent movement of the patient 210 duringsurgery.

According to an alternative embodiment, FIG. 1B is an overhead view ofan alternate arrangement for locations of a robotic system 100, patient210, surgeon 120, and other medical personnel during a cranial surgicalprocedure. During a cranial procedure, for example, the robot 102 may bepositioned behind the head 128 of the patient 210. The robot arm 104 ofthe robot 102 has an end-effector 112 that may hold a surgicalinstrument 108 during the procedure. In this example, a stereotacticframe 134 is fixed with respect to the patient's head 128, and thepatient 210 and/or stereotactic frame 134 may also be secured to apatient base 211 to prevent movement of the patient's head 128 withrespect to the patient base 211. In addition, the patient 210, thestereotactic frame 134 and/or or the patient base 211 may be secured tothe robot base 106, such as via an auxiliary arm 107, to preventrelative movement of the patient 210 with respect to components of therobot 102 during surgery. Different devices may be positioned withrespect to the patient's head 128 and/or patient base 211 as desired tofacilitate the procedure, such as an intra-operative CT device 130, ananesthesiology station 132, a scrub station 136, a neuro-modulationstation 138, and/or one or more remote pendants 140 for controlling therobot 102 and/or other devices or systems during the procedure.

The surgical robot system 100 in the examples of FIGS. 1A and/or 1B mayalso use a sensor, such as a camera 200, for example, positioned on acamera stand 202. The camera stand 202 can have any suitableconfiguration to move, orient, and support the camera 200 in a desiredposition. The camera 200 may include any suitable camera or cameras,such as one or more cameras (e.g., bifocal or stereophotogrammetriccameras), able to identify, for example, active or passive trackingmarkers 118 (shown as part of patient tracking device 116 in FIG. 2) ina given measurement volume viewable from the perspective of the camera200. In this example, the camera 200 may scan the given measurementvolume and detect the light that comes from the tracking markers 118 inorder to identify and determine the position of the tracking markers 118in three-dimensions. For example, active tracking markers 118 mayinclude infrared-emitting markers that are activated by an electricalsignal (e.g., infrared light emitting diodes (LEDs)), and/or passivetracking markers 118 may include retro-reflective markers that reflectinfrared or other light (e.g., they reflect incoming IR radiation intothe direction of the incoming light), for example, emitted byilluminators on the camera 200 or other suitable sensor or other device.

In many surgical procedures, one or more targets of surgical interest,such as targets within the brain for example, are localized to anexternal reference frame. For example, stereotactic neurosurgery may usean externally mounted stereotactic frame that facilitates patientlocalization and implant insertion via a frame mounted arc.Neuronavigation is used to register, e.g., map, targets within the brainbased on pre-operative or intraoperative imaging. Using thispre-operative or intraoperative imaging, links and associations can bemade between the imaging and the actual anatomical structures in asurgical environment, and these links and associations can be utilizedby robotic trajectory systems during surgery.

According to some embodiments, various software and hardware elementsmay be combined to create a system that can be used to plan, register,place and verify the location of an instrument or implant in the brain.These systems may integrate a surgical robot, such as the surgical robot102 of FIGS. 1A and/or 1B, and may employ a surgical navigation systemand planning software to program and control the surgical robot. Inaddition or alternatively, the surgical robot 102 may be remotelycontrolled, such as by nonsterile personnel.

The robot 102 may be positioned near or next to patient 210, and it willbe appreciated that the robot 102 can be positioned at any suitablelocation near the patient 210 depending on the area of the patient 210undergoing the operation. The camera 200 may be separated from thesurgical robot system 100 and positioned near or next to patient 210 aswell, in any suitable position that allows the camera 200 to have adirect visual line of sight to the surgical field 208. In theconfiguration shown, the surgeon 120 may be positioned across from therobot 102, but is still able to manipulate the end-effector 112 and thedisplay 110. A surgical assistant 126 may be positioned across from thesurgeon 120 again with access to both the end-effector 112 and thedisplay 110. If desired, the locations of the surgeon 120 and theassistant 126 may be reversed. The traditional areas for theanesthesiologist 122 and the nurse or scrub tech 124 may remainunimpeded by the locations of the robot 102 and camera 200.

With respect to the other components of the robot 102, the display 110can be attached to the surgical robot 102 and in other embodiments, thedisplay 110 can be detached from surgical robot 102, either within asurgical room with the surgical robot 102, or in a remote location. Theend-effector 112 may be coupled to the robot arm 104 and controlled byat least one motor. In some embodiments, end-effector 112 can comprise aguide tube 114, which is able to receive and orient a surgicalinstrument 108 used to perform surgery on the patient 210. As usedherein, the term “end-effector” is used interchangeably with the terms“end-effectuator” and “effectuator element.” Although generally shownwith a guide tube 114, it will be appreciated that the end-effector 112may be replaced with any suitable instrumentation suitable for use insurgery. In some embodiments, end-effector 112 can comprise any knownstructure for effecting the movement of the surgical instrument 108 in adesired manner.

The surgical robot 102 is able to control the translation andorientation of the end-effector 112. The robot 102 is able to moveend-effector 112 along x-, y-, and z-axes, for example. The end-effector112 can be configured for selective rotation about one or more of thex-, y-, and z-axis such that one or more of the Euler Angles (e.g.,roll, pitch, and/or yaw) associated with end-effector 112 can beselectively controlled. In some embodiments, selective control of thetranslation and orientation of end-effector 112 can permit performanceof medical procedures with significantly improved accuracy compared toconventional robots that use, for example, a six degree of freedom robotarm comprising only rotational axes. For example, the surgical robotsystem 100 may be used to operate on patient 210, and robot arm 104 canbe positioned above the body of patient 210, with end-effector 112selectively angled relative to the z-axis toward the body of patient210.

In some embodiments, the position of the surgical instrument 108 can bedynamically updated so that surgical robot 102 can be aware of thelocation of the surgical instrument 108 at all times during theprocedure. Consequently, in some embodiments, surgical robot 102 canmove the surgical instrument 108 to the desired position quickly withoutany further assistance from a physician (unless the physician sodesires). In some further embodiments, surgical robot 102 can beconfigured to correct the path of the surgical instrument 108 if thesurgical instrument 108 strays from the selected, preplanned trajectory.In some embodiments, surgical robot 102 can be configured to permitstoppage, modification, and/or manual control of the movement ofend-effector 112 and/or the surgical instrument 108. Thus, in use, insome embodiments, a physician or other user can operate the system 100,and has the option to stop, modify, or manually control the autonomousmovement of end-effector 112 and/or the surgical instrument 108. Furtherdetails of surgical robot system 100 including the control and movementof a surgical instrument 108 by surgical robot 102 can be found inco-pending U.S. Patent Publication No. 2013/0345718, which isincorporated herein by reference in its entirety.

As will be described in greater detail below, the surgical robot system100 can comprise one or more tracking markers configured to track themovement of robot arm 104, end-effector 112, patient 210, and/or thesurgical instrument 108 in three dimensions. In some embodiments, aplurality of tracking markers can be mounted (or otherwise secured)thereon to an outer surface of the robot 102, such as, for example andwithout limitation, on base 106 of robot 102, on robot arm 104, and/oron the end-effector 112. In some embodiments, such as the embodiment ofFIG. 3 below, for example, one or more tracking markers can be mountedor otherwise secured to the end-effector 112. One or more trackingmarkers can further be mounted (or otherwise secured) to the patient210. In some embodiments, the plurality of tracking markers can bepositioned on the patient 210 spaced apart from the surgical field 208to reduce the likelihood of being obscured by the surgeon, surgicaltools, or other parts of the robot 102. Further, one or more trackingmarkers can be further mounted (or otherwise secured) to the surgicalinstruments 108 (e.g., a screw driver, dilator, implant inserter, or thelike). Thus, the tracking markers enable each of the marked objects(e.g., the end-effector 112, the patient 210, and the surgicalinstruments 108) to be tracked by the surgical robot system 100. In someembodiments, system 100 can use tracking information collected from eachof the marked objects to calculate the orientation and location, forexample, of the end-effector 112, the surgical instrument 108 (e.g.,positioned in the tube 114 of the end-effector 112), and the relativeposition of the patient 210. Further details of surgical robot system100 including the control, movement and tracking of surgical robot 102and of a surgical instrument 108 can be found in U.S. Patent PublicationNo. 2016/0242849, which is incorporated herein by reference in itsentirety.

In some embodiments, pre-operative imaging may be used to identify theanatomy to be targeted in the procedure. If desired by the surgeon theplanning package will allow for the definition of a reformattedcoordinate system. This reformatted coordinate system will havecoordinate axes anchored to specific anatomical landmarks, such as theanterior commissure (AC) and posterior commissure (PC) for neurosurgeryprocedures. In some embodiments, multiple pre-operative exam images(e.g., CT or magnetic resonance (MR) images) may be co-registered suchthat it is possible to transform coordinates of any given point on theanatomy to the corresponding point on all other pre-operative examimages.

As used herein, registration is the process of determining thecoordinate transformations from one coordinate system to another. Forexample, in the co-registration of preoperative images, co-registering aCT scan to an MR scan means that it is possible to transform thecoordinates of an anatomical point from the CT scan to the correspondinganatomical location in the MR scan. It may also be advantageous toregister at least one exam image coordinate system to the coordinatesystem of a common registration fixture, such as a dynamic referencebase (DRB), which may allow the camera 200 to keep track of the positionof the patient in the camera space in real-time so that anyintraoperative movement of an anatomical point on the patient in theroom can be detected by the robot system 100 and accounted for bycompensatory movement of the surgical robot 102.

FIG. 3 is a flowchart diagram illustrating computer-implementedoperations 300 for determining a position and orientation of ananatomical feature of a patient with respect to a robot arm of asurgical robot, according to some embodiments. The operations 300 mayinclude receiving a first image volume, such as a CT scan, from apreoperative image capture device at a first time (Block 302). The firstimage volume includes an anatomical feature of a patient and at least aportion of a registration fixture that is fixed with respect to theanatomical feature of the patient. The registration fixture includes afirst plurality of fiducial markers that are fixed with respect to theregistration fixture. The operations 300 further include determining,for each fiducial marker of the first plurality of fiducial markers, aposition of the fiducial marker relative to the first image volume(Block 304). The operations 300 further include, determining, based onthe determined positions of the first plurality of fiducial markers,positions of an array of tracking markers on the registration fixture(fiducial registration array or FRA) with respect to the anatomicalfeature (Block 306).

The operations 300 may further include receiving a tracking data framefrom an intraoperative tracking device comprising a plurality oftracking cameras at a second time that is later than the first time(Block 308). The tracking frame includes positions of a plurality oftracking markers that are fixed with respect to the registration fixture(FRA) and a plurality of tracking markers that are fixed with respect tothe robot. The operations 300 further include determining, for based onthe positions of tracking markers of the registration fixture, aposition and orientation of the anatomical feature with respect to thetracking cameras (Block 310). The operations 300 further includedetermining, based on the determined positions of the plurality oftracking markers on the robot, a position and orientation of the robotarm of a surgical robot with respect to the tracking cameras (Block312).

The operations 300 further include determining, based on the determinedposition and orientation of the anatomical feature with respect to thetracking cameras and the determined position and orientation of therobot arm with respect to the tracking cameras, a position andorientation of the anatomical feature with respect to the robot arm(Block 314). The operations 300 further include controlling movement ofthe robot arm with respect to the anatomical feature, e.g., along and/orrotationally about one or more defined axis, based on the determinedposition and orientation of the anatomical feature with respect to therobot arm (Block 316).

FIG. 4 is a diagram illustrating a data flow 400 for a multiplecoordinate transformation system, to enable determining a position andorientation of an anatomical feature of a patient with respect to arobot arm of a surgical robot, according to some embodiments. In thisexample, data from a plurality of exam image spaces 402, based on aplurality of exam images, may be transformed and combined into a commonexam image space 404. The data from the common exam image space 404 anddata from a verification image space 406, based on a verification image,may be transformed and combined into a registration image space 408.Data from the registration image space 408 may be transformed intopatient fiducial coordinates 410, which is transformed into coordinatesfor a DRB 412. A tracking camera 414 may detect movement of the DRB 412(represented by DRB 412′) and may also detect a location of a probetracker 416 to track coordinates of the DRB 412 over time. A robotic armtracker 418 determines coordinates for the robot arm based ontransformation data from a Robotics Planning System (RPS) space 420 orsimilar modeling system, and/or transformation data from the trackingcamera 414.

It should be understood that these and other features may be used andcombined in different ways to achieve registration of image space, i.e.,coordinates from image volume, into tracking space, i.e., coordinatesfor use by the surgical robot in real-time. As will be discussed indetail below, these features may include fiducial-based registrationsuch as stereotactic frames with CT localizer, preoperative CT or MRIregistered using intraoperative fluoroscopy, calibrated scannerregistration where any acquired scan's coordinates are pre-calibratedrelative to the tracking space, and/or surface registration using atracked probe, for example.

In one example, FIGS. 5A-5C illustrate a system 500 for registering ananatomical feature of a patient. In this example, the stereotactic framebase 530 is fixed to an anatomical feature 528 of patient, e.g., thepatient's head. As shown by FIG. 5A, the stereotactic frame base 530 maybe affixed to the patient's head 528 prior to registration using pinsclamping the skull or other method. The stereotactic frame base 530 mayact as both a fixation platform, for holding the patient's head 528 in afixed position, and registration and tracking platform, foralternatingly holding the CT localizer 536 or the FRA fixture 534. TheCT localizer 536 includes a plurality of fiducial markers 532 (e.g.,N-pattern radio-opaque rods or other fiducials), which are automaticallydetected in the image space using image processing. Due to the preciseattachment mechanism of the CT localizer 536 to the base 530, thesefiducial markers 532 are in known space relative to the stereotacticframe base 530. A 3D CT scan of the patient with CT localizer 536attached is taken, with an image volume that includes both the patient'shead 528 and the fiducial markers 532 of the CT localizer 536. Thisregistration image can be taken intraoperatively or preoperatively,either in the operating room or in radiology, for example. The captured3D image dataset is stored to computer memory.

As shown by FIG. 5B, after the registration image is captured, the CTlocalizer 536 is removed from the stereotactic frame base 530 and theframe reference array fixture 534 is attached to the stereotactic framebase 530. The stereotactic frame base 530 remains fixed to the patient'shead 528, however, and is used to secure the patient during surgery, andserves as the attachment point of a frame reference array fixture 534.The frame reference array fixture 534 includes a frame reference array(FRA), which is a rigid array of three or more tracked markers 539,which may be the primary reference for optical tracking. By positioningthe tracked markers 539 of the FRA in a fixed, known location andorientation relative to the stereotactic frame base 530, the positionand orientation of the patient's head 528 may be tracked in real time.Mount points on the FRA fixture 534 and stereotactic frame base 530 maybe designed such that the FRA fixture 534 attaches reproducibly to thestereotactic frame base 530 with minimal (i.e., submillimetric)variability. These mount points on the stereotactic frame base 530 canbe the same mount points used by the CT localizer 536, which is removedafter the scan has been taken. An auxiliary arm (such as auxiliary arm107 of FIG. 1B, for example) or other attachment mechanism can also beused to securely affix the patient to the robot base to ensure that therobot base is not allowed to move relative to the patient.

As shown by FIG. 5C, a dynamic reference base (DRB) 540 may also beattached to the stereotactic frame base 530. The DRB 540 in this exampleincludes a rigid array of three or more tracked markers 542. In thisexample, the DRB 540 and/or other tracked markers may be attached to thestereotactic frame base 530 and/or to directly to the patient's head 528using auxiliary mounting arms 541, pins, or other attachment mechanisms.Unlike the FRA fixture 534, which mounts in only one way for unambiguouslocalization of the stereotactic frame base 530, the DRB 540 in generalmay be attached as needed for allowing unhindered surgical and equipmentaccess. Once the DRB 540 and FRA fixture 534 are attached, registration,which was initially related to the tracking markers 539 of the FRA, canbe optionally transferred or related to the tracking markers 542 of theDRB 540. For example, if any part of the FRA fixture 534 blocks surgicalaccess, the surgeon may remove the FRA fixture 534 and navigate usingonly the DRB 540. However, if the FRA fixture 534 is not in the way ofthe surgery, the surgeon could opt to navigate from the FRA markers 539,without using a DRB 540, or may navigate using both the FRA markers 539and the DRB 540. In this example, the FRA fixture 534 and/or DRB 540uses optical markers, the tracked positions of which are in knownlocations relative to the stereotactic frame base 530, similar to the CTlocalizer 536, but it should be understood that many other additionaland/or alternative techniques may be used.

FIGS. 6A and 6B illustrate a system 600 for registering an anatomicalfeature of a patient using fluoroscopy (fluoro) imaging, according tosome embodiments. In this embodiment, image space is registered totracking space using multiple intraoperative fluoroscopy (fluoro) imagestaken using a tracked registration fixture 644. The anatomical featureof the patient (e.g., the patient's head 628) is positioned and rigidlyaffixed in a clamping apparatus 643 in a static position for theremainder of the procedure. The clamping apparatus 643 for rigid patientfixation can be a three-pin fixation system such as a Mayfield clamp, astereotactic frame base attached to the surgical table, or anotherfixation method, as desired. The clamping apparatus 643 may alsofunction as a support structure for a patient tracking array or DRB 640as well. The DRB may be attached to the clamping apparatus usingauxiliary mounting arms 641 or other means.

Once the patient is positioned, the fluoro fixture 644 is attached thefluoro unit's x-ray collecting image intensifier (not shown) and securedby tightening clamping feet 632. The fluoro fixture 644 containsfiducial markers (e.g., metal spheres laid out across two planes in thisexample, not shown) that are visible on 2D fluoro images captured by thefluoro image capture device and can be used to calculate the location ofthe x-ray source relative to the image intensifier, which is typicallyabout 1 meter away contralateral to the patient, using a standardpinhole camera model. Detection of the metal spheres in the fluoro imagecaptured by the fluoro image capture device also enables the software tode-warp the fluoro image (i.e., to remove pincushion and s-distortion).Additionally, the fluoro fixture 644 contains 3 or more tracking markers646 for determining the location and orientation of the fluoro fixture644 in tracking space. In some embodiments, software can project vectorsthrough a CT image volume, based on a previously captured CT image, togenerate synthetic images based on contrast levels in the CT image thatappear similar to the actual fluoro images (i.e., digitallyreconstructed radiographs (DRRs)). By iterating through theoreticalpositions of the fluoro beam until the DRRs match the actual fluoroshots, a match can be found between fluoro image and DRR in two or moreperspectives, and based on this match, the location of the patient'shead 628 relative to the x-ray source and detector is calculated.Because the tracking markers 646 on the fluoro fixture 644 track theposition of the image intensifier and the position of the x-ray sourcerelative to the image intensifier is calculated from metal fiducials onthe fluoro fixture 644 projected on 2D images, the position of the x-raysource and detector in tracking space are known and the system is ableto achieve image-to-tracking registration.

As shown by FIGS. 6A and 6B, two or more shots are taken of the head 628of the patient by the fluoro image capture device from two differentperspectives while tracking the array markers 642 of the DRB 640, whichis fixed to the registration fixture 630 via a mounting arm 641, andtracking markers 646 on the fluoro fixture 644. Based on the trackingdata and fluoro data, an algorithm computes the location of the head 628or other anatomical feature relative to the tracking space for theprocedure. Through image-to-tracking registration, the location of anytracked tool in the image volume space can be calculated.

For example, in one embodiment, a first fluoro image taken from a firstfluoro perspective can be compared to a first DRR constructed from afirst perspective through a CT image volume, and a second fluoro imagetaken from a second fluoro perspective can be compared to a second DRRconstructed from a second perspective through the same CT image volume.Based on the comparisons, it may be determined that the first DRR issubstantially equivalent to the first fluoro image with respect to theprojected view of the anatomical feature, and that the second DRR issubstantially equivalent to the second fluoro image with respect to theprojected view of the anatomical feature. Equivalency confirms that theposition and orientation of the x-ray path from emitter to collector onthe actual fluoro machine as tracked in camera space matches theposition and orientation of the x-ray path from emitter to collector asspecified when generating the DRRs in CT space, and thereforeregistration of tracking space to CT space is achieved.

FIG. 7 illustrates a system 700 for registering an anatomical feature ofa patient using an intraoperative CT fixture (ICT) and a DRB, accordingto some embodiments. As shown in FIG. 7, in one application, afiducial-based image-to-tracking registration can be utilized that usesan intraoperative CT fixture (ICT) 750 having a plurality of trackingmarkers 751 and radio-opaque fiducial reference markers 732 to registerthe CT space to the tracking space. After stabilizing the anatomicalfeature 728 (e.g., the patient's head) using clamping apparatus 730 suchas a three-pin Mayfield frame and/or stereotactic frame, the surgeonwill affix the ICT 750 to the anatomical feature 728, DRB 740, orclamping apparatus 730, so that it is in a static position relative tothe tracking markers 742 of the DRB 740, which may be held in place bymounting arm 741 or other rigid means. A CT scan is captured thatencompasses the fiducial reference markers 732 of the ICT 750 while alsocapturing relevant anatomy of the anatomical feature 728. Once the CTscan is loaded in the software, the system auto-identifies (throughimage processing) locations of the fiducial reference markers 732 of theICT within the CT volume, which are in a fixed position relative to thetracking markers of the ICT 750, providing image-to-trackingregistration. This registration, which was initially based on thetracking markers 751 of the ICT 750, is then related to or transferredto the tracking markers 742 of the DRB 740, and the ICT 750 may then beremoved.

FIG. 8A illustrates a system 800 for registering an anatomical featureof a patient using a DRB and an X-ray cone beam imaging device,according to some embodiments. An intraoperative scanner 852, such as anX-ray machine or other scanning device, may have a tracking array 854with tracking markers 855, mounted thereon for registration. Based onthe fixed, known position of the tracking array 854 on the scanningdevice, the system may be calibrated to directly map (register) thetracking space to the image space of any scan acquired by the system.Once registration is achieved, the registration, which is initiallybased on the tracking markers 855 (e.g. gantry markers) of the scanner'sarray 854, is related or transferred to the tracking markers 842 of aDRB 840, which may be fixed to a clamping fixture 830 holding thepatient's head 828 by a mounting arm 841 or other rigid means. Aftertransferring registration, the markers on the scanner are no longer usedand can be removed, deactivated or covered if desired. Registering thetracking space to any image acquired by a scanner in this way may avoidthe need for fiducials or other reference markers in the image space insome embodiments.

FIG. 8B illustrates an alternative system 800′ that uses a portableintraoperative scanner, referred to herein as a C-arm scanner 853. Inthis example, the C-arm scanner 853 includes a c-shaped arm 856 coupledto a movable base 858 to allow the C-arm scanner 853 to be moved intoplace and removed as needed, without interfering with other aspects ofthe surgery. The arm 856 is positioned around the patient's head 828intraoperatively, and the arm 856 is rotated and/or translated withrespect to the patient's head 828 to capture the X-ray or other type ofscan that to achieve registration, at which point the C-arm scanner 853may be removed from the patient.

Another registration method for an anatomical feature of a patient,e.g., a patient's head, may be to use a surface contour map of theanatomical feature, according to some embodiments. A surface contour mapmay be constructed using a navigated or tracked probe, or othermeasuring or sensing device, such as a laser pointer, 3D camera, etc.For example, a surgeon may drag or sequentially touch points on thesurface of the head with the navigated probe to capture the surfaceacross unique protrusions, such as zygomatic bones, superciliary arches,bridge of nose, eyebrows, etc. The system then compares the resultingsurface contours to contours detected from the CT and/or MR images,seeking the location and orientation of contour that provides theclosest match. To account for movement of the patient and to ensure thatall contour points are taken relative to the same anatomical feature,each contour point is related to tracking markers on a DRB on thepatient at the time it is recorded. Since the location of the contourmap is known in tracking space from the tracked probe and tracked DRB,tracking-to-image registration is obtained once the correspondingcontour is found in image space.

FIG. 9 illustrates a system 900 for registering an anatomical feature ofa patient using a navigated or tracked probe and fiducials forpoint-to-point mapping of the anatomical feature 928 (e.g., a patient'shead), according to some embodiments. Software would instruct the userto point with a tracked probe to a series of anatomical landmark pointsthat can be found in the CT or MR image. When the user points to thelandmark indicated by software, the system captures a frame of trackingdata with the tracked locations of tracking markers on the probe and onthe DRB. From the tracked locations of markers on the probe, thecoordinates of the tip of the probe are calculated and related to thelocations of markers on the DRB. Once 3 or more points are found in bothspaces, tracking-to-image registration is achieved. As an alternative topointing to natural anatomical landmarks, fiducials 954 (i.e., fiducialmarkers), such as sticker fiducials or metal fiducials, may be used. Thesurgeon will attach the fiducials 954 to the patient, which areconstructed of material that is opaque on imaging, for examplecontaining metal if used with CT or Vitamin E if used with MR. Imaging(CT or MR) will occur after placing the fiducials 954. The surgeon oruser will then manually find the coordinates of the fiducials in theimage volume, or the software will find them automatically with imageprocessing. After attaching a DRB 940 with tracking markers 942 to thepatient through a mounting arm 941 connected to a clamping apparatus 930or other rigid means, the surgeon or user may also locate the fiducials954 in physical space relative to the DRB 940 by touching the fiducials954 with a tracked probe while simultaneously recording tracking markerson the probe (not shown) and on the DRB 940. Registration is achievedbecause the coordinates of the same points are known in the image spaceand the tracking space.

One use for the embodiments described herein is to plan trajectories andto control a robot to move into a desired trajectory, after which thesurgeon will place implants such as electrodes through a guide tube heldby the robot. Additional functionalities include exporting coordinatesused with existing stereotactic frames, such as a Leksell frame, whichuses five coordinates: X, Y, Z, Ring Angle and Arc Angle. These fivecoordinates are established using the target and trajectory identifiedin the planning stage relative to the image space and knowing theposition and orientation of the ring and arc relative to thestereotactic frame base or other registration fixture.

As shown in FIG. 10, stereotactic frames allow a target location 1058 ofan anatomical feature 1028 (e.g., a patient's head) to be treated as thecenter of a sphere and the trajectory can pivot about the targetlocation 1058. The trajectory to the target location 1058 is adjusted bythe ring and arc angles of the stereotactic frame (e.g., a Leksellframe). These coordinates may be set manually, and the stereotacticframe may be used as a backup or as a redundant system in case the robotfails or cannot be tracked or registered successfully. The linear x, y,z offsets to the center point (i.e., target location 1058) are adjustedvia the mechanisms of the frame. A cone 1060 is centered around thetarget location 1058, and shows the adjustment zone that can be achievedby modifying the ring and arc angles of the Leksell or other type offrame. This figure illustrates that a stereotactic frame with ring andarc adjustments is well suited for reaching a fixed target location froma range of angles while changing the entry point into the skull.

FIG. 11 illustrates a two-dimensional visualization of virtual pointrotation mechanism, according to some embodiments. In this embodiment,the robotic arm is able to create a different type of point-rotationfunctionality that enables a new movement mode that is not easilyachievable with a 5-axis mechanical frame, but that may be achievedusing the embodiments described herein. Through coordinated control ofthe robot's axes using the registration techniques described herein,this mode allows the user to pivot the robot's guide tube about anyfixed point in space. For example, the robot may pivot about the entrypoint 1162 into the anatomical feature 1128 (e.g., a patient's head).This entry point pivoting is advantageous as it allows the user to makea smaller burr hole without limiting their ability to adjust the targetlocation 1164 intraoperatively. The cone 1160 represents the range oftrajectories that may be reachable through a single entry hole.Additionally, entry point pivoting is advantageous as it allows the userto reach two different target locations 1164 and 1166 through the samesmall entry burr hole. Alternately, the robot may pivot about a targetpoint (e.g., location 1058 shown in FIG. 10) within the skull to reachthe target location from different angles or trajectories, asillustrated in FIG. 10. Such interior pivoting robotically has the sameadvantages as a stereotactic frame as it allows the user to approach thesame target location 1058 from multiple approaches, such as whenirradiating a tumor or when adjusting a path so that critical structuressuch as blood vessels or nerves will not be crossed when reachingtargets beyond them. Unlike a stereotactic frame, which relies on fixedring and arc articulations to keep a target/pivot point fixed, the robotadjusts the pivot point through controlled activation of axes and therobot can therefore dynamically adjust its pivot point and switch asneeded between the modes illustrated in FIGS. 10 and 11.

Following the insertion of implants or instrumentation using the robotor ring and arc fixture, these and other embodiments may allow forimplant locations to be verified using intraoperative imaging. Placementaccuracy of the instrument or implant relative to the planned trajectorycan be qualitatively and/or quantitatively shown to the user. One optionfor comparing planned to placed position is to merge a postoperativeverification CT image to any of the preoperative images. Once pre- andpost-operative images are merged and plan is shown overlaid, the shadowof the implant on postop CT can be compared to the plan to assessaccuracy of placement. Detection of the shadow artifact on post-op CTcan be performed automatically through image processing and the offsetdisplayed numerically in terms of millimeters offset at the tip andentry and angular offset along the path. This option does not requireany fiducials to be present in the verification image sinceimage-to-image registration is performed based on bony anatomicalcontours.

A second option for comparing planned position to the final placementwould utilize intraoperative fluoro with or without an attached fluorofixture. Two out-of-plane fluoro images will be taken and these fluoroimages will be matched to DRRs generated from pre-operative CT or MR asdescribed above for registration. Unlike some of the registrationmethods described above, however, it may be less important for thefluoro images to be tracked because the key information is where theelectrode is located relative to the anatomy in the fluoro image. Thelinear or slightly curved shadow of the electrode would be found on afluoro image, and once the DRR corresponding to that fluoro shot isfound, this shadow can be replicated in the CT image volume as a planeor sheet that is oriented in and out of the ray direction of the fluoroimage and DRR. That is, the system may not know how deep in or out ofthe fluoro image plane the electrode lies on a given shot, but cancalculate the plane or sheet of possible locations and represent thisplane or sheet on the 3D volume. In a second fluoro view, a differentplane or sheet can be determined and overlaid on the 3D image. Wherethese two planes or sheets intersect on the 3D image is the detectedpath of the electrode. The system can represent this detected path as agraphic on the 3D image volume and allow the user to reslice the imagevolume to display this path and the planned path from whateverperspective is desired, also allowing automatic or manual calculation ofthe deviation from planned to placed position of the electrode. Trackingthe fluoro fixture is unnecessary but may be done to help de-warp thefluoro images and calculate the location of the x-ray emitter to improveaccuracy of DRR calculation, the rate of convergence when iterating tofind matching DRR and fluoro shots, and placement of sheets/planesrepresenting the electrode on the 3D scan.

In this and other examples, it is desirable to maintain navigationintegrity, i.e., to ensure that the registration and tracking remainaccurate throughout the procedure. Two primary methods to establish andmaintain navigation integrity include: tracking the position of asurveillance marker relative to the markers on the DRB, and checkinglandmarks within the images. In the first method, should this positionchange due to, for example, the DRB being bumped, then the system mayalert the user of a possible loss of navigation integrity. In the secondmethod, if a landmark check shows that the anatomy represented in thedisplayed slices on screen does not match the anatomy at which the tipof the probe points, then the surgeon will also become aware that thereis a loss of navigation integrity. In either method, if using theregistration method of CT localizer and frame reference array (FRA), thesurgeon has the option to re-attach the FRA, which mounts in only onepossible way to the frame base, and to restore tracking-to-imageregistration based on the FRA tracking markers and the stored fiducialsfrom the CT localizer 536. This registration can then be transferred orrelated to tracking markers on a repositioned DRB. Once registration istransferred the FRA can be removed if desired.

In another embodiment, there is provided a system and method for moreefficient placement of electrodes into the brain using the roboticsystem disclosed above. As background, the brain includes the cerebralcortex 1200 which is comprised of sulci 1202 and gyri 1204, asillustrated in FIG. 12. In an embodiment in which electrodes arepositioned within the brain to cause stimulation, the above disclosedrobotic system provides a more accurate and efficient system and methodfor deep brain stimulation (DBS). In an exemplary method, DBS electrodesare positioned in the brain through the gyms 1204 and avoid penetratingthrough the sulcus 1202, especially at or near the surface of thecerebral cortex. Similarly, the surgeon avoids passing the electrodethrough any region of the brain posterior to the coronal bony structure.

Now turning to FIGS. 13A and 13B, a computer system with software may beused to plan a linear trajectory 206 of an electrode into a targetlocation deep within the brain. The surgeon first selects the targetstructure (e.g., subthalamic nucleus, globus pallidus interna, ventralintermediate nucleus) and then either estimates a first trajectory basedon default angles away from the target, e.g., 15 degrees from themidsagittal plane and 60 degrees from the axial plane (FIG. 13), orrequires the user to select an entry point anatomically. By scrollingthrough an image on the display of the computer system, the surgeonvisually evaluates this linear trajectory and manipulates the plannedentry position of the electrode into the skull (tail of the electrode)to make adjustments to the plan to try to reduce the frequency ofintersection of the electrode path with deep sulci and place theelectrode centered through a superficial gyms. The process of selectingthe linear trajectory 1206 can vary depending on which planes thesurgeon scrolls on the image when adjusting the trajectory. In otherembodiments, the surgeon may adjust the path to the target by avoidingpassing through regions of the brain that are known to be responsiblefor certain cognitive functions, avoiding passing through blood vessels,and avoiding the caudate nucleus.

FIGS. 13A and 13B illustrates the planning a trajectory for positioningan electrode 1206 deep within the brain. Specifically, FIGS. 13A and 13Bshow planning trajectories on a magnetic resonance image (MM) of DBSelectrodes into the brain. FIG. 13A illustrates the initial planauto-generated by the software and FIG. 13B illustrates the improvedtrajectory after manual adjustment by the surgeon.

In an exemplary embodiment of the invention, image processing is used toanalyze regions of the brain at and near the first trajectory,predicting and suggesting which direction and by how much the surgeonshould move to meet the conditions for optimal placement of theelectrode.

For evaluating possible electrode trajectories, image processing enablesa small region surrounding the planned path of the electrode to beevaluated to determine the number of times the trajectory passes“in-out-in” through brain folds. To automatically determine whether afeature of the brain is a sulcus or a gyms, machine learning or templatematching may be used, with computerized models trained on the appearanceon medical images of a sulcus or gyms. Alternatively, an imageprocessing algorithm utilized to determine the curvature of anencountered cerebral cortex fold relative to the visceral or parietaldirection to determine if the structure is considered a gyms (convex) orsulcus (concave).

As a result, an accuracy score may be used to determine the besttrajectory for placement of the electrode. The accuracy score may beconstructed by applying weighting factors to the differentconsiderations according to importance. In another embodiment, if themost important consideration is not penetrating a superficial sulcus,then each penetration of a sulcus would reduce the accuracy score by agreater amount than a less important factor such as distance anterior tothe coronal suture. In some embodiments it is more important to avoidsuperficial sulci than deep sulci, as a result in these embodiments thedepth of the encountered sulcus could inversely scale the amount bywhich the score is reduced. The score would also drop proportionally tothe amount by which it is off-center when passing the electrode througha gyms (i.e., the closer it gets to a sulcus).

In yet another embodiment, the system may provide options for revisedand improved trajectories, with the ability to narrow the list ofoptions according to a set of rules provided by the user. In yet anotherembodiment, the user may visualize options that are within a 10-degreeradius of the current location in all directions. The user may also seeoptions that are within a 15-degree radius in a specified plane, such asthe coronal plane. In another embodiment, the user may visualize optionsthat increase the accuracy score by greater than 20%.

In another embodiment, the system provides a method for displaying thelocation or locations of best entry into the skull for the desiredtarget, by generating a map of the surface of the skull or brain thatindicates by use of visual characteristics such as colors to indicatethe accuracy score of the electrode path according to the criteriadetermined by the user. In one exemplary embodiment the trajectories ofhigher accuracy scores could be displayed a color more toward the greenend of a red-yellow-green scale and the trajectories of a lower accuracyscore may be displayed as a color more toward the red end of the samescale.

In another embodiment, the robot system may be used in an active modewhen a surgeon manually drives the robot arm through a range ofpositions, each representing a different entry point but the same distaltarget point within the brain. At each position, a computerized meter ora light could indicate to the user the quality of the linear trajectoryto the target point. For example, a light mounted on the end effectorcould glow green when the end effector is moved into a more accuratetrajectory, with the light glowing red when moved to a less accurateposition. In another embodiment, a gradation of green through yellowthrough red light may be emitted at different accuracy positions,providing a continuous scale of poor to accurate as the user moves theend effector. In another embodiment, a laser light of varying colorand/or intensity may be emitted on the surface of the cranium as theuser moves the end effector. Alternately, the system may also utilizehaptic feedback to help guide the user to position the end effectoraccurately. In another embodiment, the surgeon may move the robot armthrough a range of possible orientations, each of which has the sametarget location but different skull entry locations. In yet anotherembodiment, the robot's end effector is configured to vibrate dependingon accuracy score. In other embodiments, various types of vibrations mayindicate different degrees of accuracy. In one embodiment, timedvibrations may indicate a more accurate position as the end effector isand no vibrations could indicate an inaccurate positioning. Alternately,the robot system may utilize a “gravity” mode, wherein, when an appliedforce is applied by the user, the robot arm would automatically positionthe end effector toward the nearest and most accurate entry location. Inanother embodiment, an applied force by the user may also move the robotarm off that trajectory and automatically cause the robot arm to movethe end effector toward then next closest accurate location with theaccuracy score exceeding a base threshold.

Using the methods disclosed above, the present disclosure provides asystem and method for the placement of stereoelectroencephalography(Stereo-EEG) depth electrodes. For Stereo-EEG electrodes, athree-dimensional grid of electrodes is placed in targeted brain areasto monitor brain activity and precisely locate seizure sources. In thesecases, 2-30 electrodes may be placed within the brain for seizuremonitoring. In one embodiment, each individual electrode is positionedat a specific target point. In another embodiment, multiple electrodesmay be positioned in specific boundary shape around a target pointwithin the brain. In another embodiment, electrodes may be positionedbased on a mean geometric location of an intended 3D grid of targetpoints deep within the brain. The robotic system may then guide thesurgeon to an entry location on the skull that allows for an accuratepathway for placing the multiple or grid of electrodes such that theelectrodes are spaced apart from the entry point to be above to cover amaximum area. In another embodiment, the robotic system may guide thesurgeon to multiple entry points on the brain surface such that for eachdeep point, the trajectory of the highest accuracy score is utilized. Aswith the system and methods described above, the system guides the userto one or more options, providing lighting, mapping, or haptic feedbackto allow new accurate trajectories that are dynamically selected at thetime of surgery.

In the above-description of various embodiments of present inventiveconcepts, it is to be understood that the terminology used herein is forthe purpose of describing particular embodiments only and is notintended to be limiting of present inventive concepts. Unless otherwisedefined, all terms (including technical and scientific terms) usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which present inventive concepts belong. It will befurther understood that terms, such as those defined in commonly useddictionaries, should be interpreted as having a meaning that isconsistent with their meaning in the context of this specification andthe relevant art and will not be interpreted in an idealized or overlyformal sense unless expressly so defined herein.

When an element is referred to as being “connected”, “coupled”,“responsive”, or variants thereof to another element, it can be directlyconnected, coupled, or responsive to the other element or interveningelements may be present. In contrast, when an element is referred to asbeing “directly connected”, “directly coupled”, “directly responsive”,or variants thereof to another element, there are no interveningelements present. Like numbers refer to like elements throughout.Furthermore, “coupled”, “connected”, “responsive”, or variants thereofas used herein may include wirelessly coupled, connected, or responsive.As used herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. Well-known functions or constructions may not be described indetail for brevity and/or clarity. The term “and/or” includes any andall combinations of one or more of the associated listed items.

It will be understood that although the terms first, second, third, etc.may be used herein to describe various elements/operations, theseelements/operations should not be limited by these terms. These termsare only used to distinguish one element/operation from anotherelement/operation. Thus a first element/operation in some embodimentscould be termed a second element/operation in other embodiments withoutdeparting from the teachings of present inventive concepts. The samereference numerals or the same reference designators denote the same orsimilar elements throughout the specification.

As used herein, the terms “comprise”, “comprising”, “comprises”,“include”, “including”, “includes”, “have”, “has”, “having”, or variantsthereof are open-ended, and include one or more stated features,integers, elements, steps, components or functions but does not precludethe presence or addition of one or more other features, integers,elements, steps, components, functions or groups thereof. Furthermore,as used herein, the common abbreviation “e.g.”, which derives from theLatin phrase “exempli gratia,” may be used to introduce or specify ageneral example or examples of a previously mentioned item, and is notintended to be limiting of such item. The common abbreviation “i.e.”,which derives from the Latin phrase “id est,” may be used to specify aparticular item from a more general recitation.

Example embodiments are described herein with reference to blockdiagrams and/or flowchart illustrations of computer-implemented methods,apparatus (systems and/or devices) and/or computer program products. Itis understood that a block of the block diagrams and/or flowchartillustrations, and combinations of blocks in the block diagrams and/orflowchart illustrations, can be implemented by computer programinstructions that are performed by one or more computer circuits. Thesecomputer program instructions may be provided to a processor circuit ofa general purpose computer circuit, special purpose computer circuit,and/or other programmable data processing circuit to produce a machine,such that the instructions, which execute via the processor of thecomputer and/or other programmable data processing apparatus, transformand control transistors, values stored in memory locations, and otherhardware components within such circuitry to implement thefunctions/acts specified in the block diagrams and/or flowchart block orblocks, and thereby create means (functionality) and/or structure forimplementing the functions/acts specified in the block diagrams and/orflowchart block(s).

These computer program instructions may also be stored in a tangiblecomputer-readable medium that can direct a computer or otherprogrammable data processing apparatus to function in a particularmanner, such that the instructions stored in the computer-readablemedium produce an article of manufacture including instructions whichimplement the functions/acts specified in the block diagrams and/orflowchart block or blocks. Accordingly, embodiments of present inventiveconcepts may be embodied in hardware and/or in software (includingfirmware, resident software, micro-code, etc.) that runs on a processorsuch as a digital signal processor, which may collectively be referredto as “circuitry,” “a module” or variants thereof.

It should also be noted that in some alternate implementations, thefunctions/acts noted in the blocks may occur out of the order noted inthe flowcharts. For example, two blocks shown in succession may in factbe executed substantially concurrently or the blocks may sometimes beexecuted in the reverse order, depending upon the functionality/actsinvolved. Moreover, the functionality of a given block of the flowchartsand/or block diagrams may be separated into multiple blocks and/or thefunctionality of two or more blocks of the flowcharts and/or blockdiagrams may be at least partially integrated. Finally, other blocks maybe added/inserted between the blocks that are illustrated, and/orblocks/operations may be omitted without departing from the scope ofinventive concepts. Moreover, although some of the diagrams includearrows on communication paths to show a primary direction ofcommunication, it is to be understood that communication may occur inthe opposite direction to the depicted arrows.

Although several embodiments of inventive concepts have been disclosedin the foregoing specification, it is understood that many modificationsand other embodiments of inventive concepts will come to mind to whichinventive concepts pertain, having the benefit of teachings presented inthe foregoing description and associated drawings. It is thus understoodthat inventive concepts are not limited to the specific embodimentsdisclosed hereinabove, and that many modifications and other embodimentsare intended to be included within the scope of the appended claims. Itis further envisioned that features from one embodiment may be combinedor used with the features from a different embodiment(s) describedherein. Moreover, although specific terms are employed herein, as wellas in the claims which follow, they are used only in a generic anddescriptive sense, and not for the purposes of limiting the describedinventive concepts, nor the claims which follow. The entire disclosureof each patent and patent publication cited herein is incorporated byreference herein in its entirety, as if each such patent or publicationwere individually incorporated by reference herein. Various featuresand/or potential advantages of inventive concepts are set forth in thefollowing claims.

What is claimed is:
 1. A system comprising: a processor circuit; and amemory comprising machine-readable instructions configured to cause theprocessor circuit to: provide a medical image volume defining an imagespace, the medical image volume comprising: an anatomical feature of apatient; a registration fixture that is fixed with respect to theanatomical feature of the patient; and a plurality of fiducial markersthat are fixed with respect to the registration fixture; based on themedical image volume, determine, for each fiducial marker of theplurality of fiducial markers, a position of the fiducial marker withrespect to the image space; determine, based on the determined positionsof the plurality of fiducial markers, a position and orientation of theregistration fixture with respect to the anatomical feature; provide atracking data frame defining a tracking space, the tracking data framecomprising positions of a first plurality of tracked markers that arefixed with respect to the registration fixture; and based on thetracking data frame, determine a position of the anatomical feature withrespect to the first plurality of tracked markers in the tracking space,an electrode configured to be positioned within the anatomical feature,wherein the anatomical feature is a cerebral cortex.
 2. The system ofclaim 1, wherein the tracking data frame further comprises positions ofa second plurality of tracked markers that are fixed with respect to apatient support structure, wherein the anatomical feature of the patientis fixed with respect to the patient support structure, and wherein themachine-readable instructions are further configured to cause theprocessor circuit to: based on the tracking data frame and thedetermined position of the anatomical feature with respect to the firstplurality of tracked markers in the tracking space, determine a positionof the anatomical feature with respect to the second plurality oftracked markers in the tracking space.
 3. The system of claim 1, whereinthe electrode is positioned in the cerebral cortex based on accuracyscore based on a formula determining whether the cerebral cortexstructure is a gyms or a sulcus.
 4. The system of claim 3, wherein theelectrode placement is based on a computer generated trajectory thatpositions the electrode through the gyms and avoids penetrating thesulcus.
 5. The system of claim 3, wherein the accuracy score isdetermined by the avoidance of the sulcus and distance between thesulcus and the optimal trajectory through the gyms.
 6. The system ofclaim 1, wherein the system includes a robotic arm coupled to a base. 7.The system of claim 3, wherein a computer generated image of thecerebral cortex is presented and configured to display the locations ofmultiple trajectories based on the accuracy score.
 8. The system ofclaim 6, wherein the robotic arm is configured to be in an active mode,wherein a user manually moves the robotic arm through a range ofpositions representing different entry points into the cerebral cortex,wherein an indicator is configured to indicate visually, audibly, orthrough haptic feedback the best trajectory based on the accuracy score.9. The system of claim 8, wherein the haptic feedback is a vibrationbased feedback system.
 10. A system comprising: a processor circuit; anda memory comprising machine-readable instructions configured to causethe processor circuit to: provide a medical image volume defining animage space, the medical image volume comprising: a cerebral cortex of apatient; a registration fixture that is fixed with respect to thecerebral cortex of the patient; and a plurality of fiducial markers thatare fixed with respect to the registration fixture; based on the medicalimage volume, determine, for each fiducial marker of the plurality offiducial markers, a position of the fiducial marker with respect to theimage space; determine, based on the determined positions of theplurality of fiducial markers, a position and orientation of theregistration fixture with respect to the cerebral cortex; provide atracking data frame defining a tracking space, the tracking data framecomprising positions of a first plurality of tracked markers that arefixed with respect to the registration fixture; and based on thetracking data frame, determine a position of the cerebral cortex withrespect to the first plurality of tracked markers in the tracking space,a plurality of Stereo-EEG depth electrodes configured to be positionedwithin the cerebral cortex.
 11. The system of claim 10, wherein thestereo-EEG depth electrodes are positioned in a three dimensional gridwithin the cerebral cortex based on accuracy score determined by formulagenerated by whether the cerebral cortex structure is a gyms or asulcus, and whether the access to a target site requires the penetrationof the sulcus.
 12. The system of claim 11, wherein the electrodeplacement is based on a computer generated trajectory that positions theelectrode through the gyms and avoids penetrating the sulcus.
 13. Thesystem of claim 11, wherein the accuracy score is determined by theavoidance of the sulcus and distance between the sulcus and the optimaltrajectory through the gyms to the target site.
 14. The system of claim11, wherein the system includes a robotic arm coupled to a base.
 15. Thesystem of claim 14, wherein the robotic arm is configured to be in anactive mode, wherein a user manually moves the robotic arm through arange of positions representing different entry points into the cerebralcortex, wherein an indicator is configured to indicate visually,audibly, or through haptic feedback the best trajectory based on theaccuracy score.
 16. The system of claim 15, wherein the haptic feedbackis a vibration based feedback system.
 17. A robotic system comprising: arobotic arm coupled to a base; a display coupled to the base; an imagingdevice operationally coupled to the robotic arm and the display; aprocessor circuit; and a memory comprising machine-readable instructionsconfigured to cause the processor circuit to: provide a medical imagevolume defining an image space, the medical image volume comprising: ananatomical feature of a patient; a registration fixture that is fixedwith respect to the anatomical feature of the patient; and a pluralityof fiducial markers that are fixed with respect to the registrationfixture; based on the medical image volume, determine, for each fiducialmarker of the plurality of fiducial markers, a position of the fiducialmarker with respect to the image space; determine, based on thedetermined positions of the plurality of fiducial markers, a positionand orientation of the registration fixture with respect to theanatomical feature; provide a tracking data frame defining a trackingspace, the tracking data frame comprising positions of a first pluralityof tracked markers that are fixed with respect to the registrationfixture; and based on the tracking data frame, determine a position ofthe anatomical feature with respect to the first plurality of trackedmarkers in the tracking space, an electrode configured to be positionedwithin the anatomical feature, wherein the anatomical feature is acerebral cortex.
 18. The robotic system of claim 17, wherein the displayis an augmented reality headgear.
 19. The robotic system of claim 17,wherein the robotic arm is coupled to an end effector.
 20. The roboticsystem of claim 19, wherein the end effector includes a plurality oftracking markers.